[HSF] Standard of care for lawyers {OT}

[Ani Anyanwu]

Hal and Tea
 
Thank you for dragging me into this discussion about ICU which I had tried to stay out of! Tea I by no means profess to expertise and know little about this but was just giving a response to a comment made by Hal and my response was to do with medical ethics than with ICU care. Anyway both of you in criticizing my institutional model (Tea I know you will say you never criticised me but I dont care!)  conveniently ignored my statement I made that the system in my ICU is not perfect so I was by no means saying we had it right or anyway close to right. You have both been in my ORs and as Hal rightly pointed out there are a lot of inadequacies and inefficiencies you can observe.
 
Anyway since you both bring up our ICU system I will expand a little just to clarify. On the nights we have a PA covering we also actually have an attending intensivist in house. These intensivists are anesthesiology attendings who work exclusively in our unit (with varied OR responsibilities of 0-75% of their time). So we do have an MD coverage all times and about 70% of the week (including daytime weekends) a consultant intensivist is in house.
 
Mind you i am not sure having an MD is necessary and am surprised that both yourself and Tea seemed to find it absurd that I criticized your ER doc based system and then described a system based on physician's assistant. A cardiothoracic physicians assistant is a far more skilled person than an ER doctor, indeed than almost any doctor (who is not a CT surgeon, CT anesthesiologist or CT intensivist), in taking care of the post surgical patient. Indeed the PAs who have done this for years are generally more skilled at this task than the residents that you seem to advocate as superior cover (although I know neither of you really believe so) and probably the new intensivists you will hire. I put it to you that both of you get a far better quality or assistance and care from you PAs than an academic institution gets from its residents. I bet if the academic center near you sent there fellows to help with one of those reop triple valve triple CABs you do, then you will thank your God for your PAs. Remember that a surgical PA is part of your team and will often represent your interests and your patient's interests very well in a vested manner. 
 
Personally given several models in the US I would happily have my surgery in a center with 24hr dedicated SURGICAL PA coverage with physicians as back up and available when necessary but ER docs is certainly a no no.
 
Ani
 



> From: Hgrmd at aol.com> Date: Sat, 12 Apr 2008 06:30:41 -0400> Subject: Re: [HSF] Standard of care for lawyers {OT}> To: OpenHeart-L at lists.hsforum.com> CC: > > Tea,> You know, until you pointed it out, I didn't realize Ani's service had > huge gaps in physician coverage as well. Does Ani let his patients know that > P.A.'s are covering most nights, or that the CT resident takes off as soon as > the 60 hours is reached, or that the CT resident may be the one actually doing > the operation? I know residents have to get trained, but I promise you that > a much shorter clamp time occurs when somebody like me does the case, > instead of a resident being guided by an attending. In fact, I've been in Ani's > OR's. Quite frankly, I had to bite my tongue to keep from pointing out some > obvious technical inefficiencies that were being done. This may be a little > below the belt, but with you having been in my OR, I suspect you know what I'm > talking about.> > Hal> > > > **************It's Tax Time! Get tips, forms and advice on AOL Money & > Finance. (http://money.aol.com/tax?NCID=aolcmp00300000002850)> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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